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Std step therapy drugs 20111101 '2011'.doc

STANDARD Stepped Therapy Agents ~ 2011
The following drugs will require prior authorization if the condition is not met when the pharmacist would attempt to
transmit a prescription claim.
Your doctor will coordinate this approval for you. If the prescription is approved, Coventry
Health Care will cover the cost. You will be responsible for the copayment. If the request is not approved, it does not mean
your doctor cannot prescribe the medicine for you. It means that you are responsible for paying the prescription in full. Self-
administered injectable agents also require prior authorization and can be found on a separate list.
Drug
Condition
Trial & failure of Risperdal* or Seroquel Trial & failure of metformin/ER (at least 1500mg/d) Trial & failure of metformin/ER (at least 1500mg/d) ActoPLUS Met XR (pioglitazone / metformin ext rel) Trial & failure of metformin/ER (at least 1500mg/d) Ambien CR (zolpidem extended release) Trial & failure of Ambien* or Sonata*, AND Lunesta Trial & failure of Lactulose* or Miralax* Trial of Aricept 10mg QD for at least 3 months Trial & failure of Flonase* or Nasalide*, AND Nasonex Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC Coreg CR (carvedilol extended rel) Trial & failure of Mevacor*, Pravachol* or Zocor* Detrol / Detrol LA (tolterodine / extended release) Trial & failure of Ditropan* or Sanctura/Sanctura XL Trial & failure of metformin/ER (at least 1500mg/d) Effexor XR* capsules (venlafaxine extended rel) Trial & failure of Ditropan* or Sanctura/Sanctura XL Trial & failure of Risperdal* or Seroquel Trial & failure of metformin/ER (at least 1500mg/d) Gelnique (oxybutynin topical gel) Trial & failure of Ditropan* or Sanctura/Sanctura XL Trial & failure of Risperdal* or Seroquel Trial & failure of metformin/ER (at least 1500mg/d) Trial & failure of Neurontin* and Lidoderm Trial & failure of Tenex* or Catapres*, AND a stimulant Trial & failure of Risperdal* or Seroquel Janumet (sitagliptin / metformin) Trial & failure of metformin/ER (at least 1500mg/d) Trial & failure of metformin/ER (at least 1500mg/d) Trial & failure of Tenex* or Catapres*, AND a stimulant Trial & failure of metformin/ER (at least 1500mg/d) Trial & failure of Risperdal* or Seroquel Trial & failure of Mevacor*, Pravachol* or Zocor*, AND Crestor Trial & failure of Apriso, Asacol or Asacol HD Trial & failure of Mevacor*, Pravachol* or Zocor*, AND Crestor This is the most current list at the time of printing and is subject to change. Last update November 1, 2011 Trial & failure of Ambien* or Sonata* Luvox CR (fluvoxamine extended release) Trial & failure of Flonase* or Nasalide*, AND Nasonex Trial & failure of Flonase* or Nasalide*, AND Nasonex Trial & failure of metformin/ER (at least 1500mg/d) Trial & failure of Ditropan* or Sanctura/Sanctura XL Paxil CR* (paroxetine extended release) Trial & failure of Flonase* or Nasalide*, AND Nasonex Trial & failure of Ambien* or Sonata*, AND Lunesta Trial & failure of Risperdal* or Seroquel Trial & failure of oral Toradol* AND one additional NSAID Symbyax (olanzapine / fluoxetine) Trial & failure of Risperdal* or Seroquel Trial & failure of Ditropan* or Sanctura/Sanctura XL Trial & failure of metformin/ER (at least 1500mg/d), AND Actos or Duetact, AND Januvia/Janumet or Onglyza/Kombiglyze Ultram ER (tramadol extended release) Trial & failure of Flonase* or Nasalide*, AND Nasonex Trial & failure of Ditropan* or Sanctura/Sanctura XL Vytorin (simvastatin/ezetimibe) 10/10 only Trial & failure of Mevacor*, Pravachol* or Zocor* Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC Trial & failure of Risperdal* or Seroquel * indicates generic available Italics indicate non-formulary agents # indicates Step Therapy required for age 18yr and under; Prior Auth required for age 19yr and over This is the most current list at the time of printing and is subject to change. Last update November 1, 2011

Source: http://carelinkcoventryhpn.coventryhealthcare.com/web/groups/public/@cvty_regional/documents/webcontent/c057982.pdf

Sap 4

AUDIT GUIDANCE STATEMENT Existence and Valuation of Inventories in the Context of the Historical Cost System This Statement of Auditing Practice was approved by the Council of the Institute of Singapore Chartered Accountants (formerly known as Institute of Certified Public Accountants of Singapore) in May 1985. SAP 4 superseded the SAP of the same title in June 2004. No sub

Curriculum vitae

Curriculum Vitae August 16, 2012 Medical Licenses: Texas: J0175 DUNS #: 96-060-3116 Board Certifications: Diplomate American Board of Anesthesiology #32715 Diplomate American Board of Pain Management Certification: Certified for outpatient management of opioid dependency. Fellowship Training: Pain Management University of Texas Health Science Center University of Texas Health Science Ce

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